Category Archives: Midwifery

Thought I’d post an update on where I’m at with “going back to school and completely changing careers”.

I start Nursing School at Wenatchee Valley College in 17 days! It’s a 2-year ADN (Associates of Nursing) degree. As preparation, I completed a CNA course over the summer. I walked into class saying “I’m not sure if I want to be a nurse, or if I want to become a doctor.” But after spending 8 weeks with a phenomenal and passionate teacher and LOVING clinicals, I feel really comfortable with my decision to go to nursing school.

I’m currently working (very) part-time as a Nursing Assistant Registered and med aid at an adult family home which means I can give patients medication (which is scary and cool). I’m enjoying the work way more than I thought I would.

This fall I’ll take my NACES exam to become a Certified Nursing Assistant (CNA).

I was incredibly fortunate to receive an Opportunity Grant from the state of Washington that covers my books (check out the stack in my pic) and part of my tuition! Plus the awesome Wenatchee Valley College Foundation gave each nursing student about $500-$600 worth of supplies including our lab supplies, a Littmann stethoscope (check it out in my pic) and our uniforms (navy blue scrubs with white shoes). Can I also just say I’m so glad to be in navy blue instead of white?

The more I learn about nursing, the less confident I am about what I’m going to do after I graduate. There are a ton of options within the nursing field, and I’m looking forward to exploring them. Maybe I’ll even become a traveling nurse. I am so happy with my decision to change paths and so thankful for the support of those around me.

Next quarter I’ll take Anatomy & Physiology II and Lifespan Psychology (and I may add in a chemistry class for “fun”).

This summer I’ll take a quick CNA (Certified Nurse Assistant) course, which I’ve heard is helpful for getting acclimated to the nursing culture.

In June I’ll apply to the ADN (Associates in Nursing) at Wenatchee Valley College for the fall quarter. The program is 2 years long. Upon graduation I will qualify to take the NCLEX-RN exam after which I will be able to apply to master’s programs for midwifery. The midwifery program will probably take 3 years.

So if all goes well I’ll be in school until 2020!

So far it’s been amazing to see God orchestrate so many details that continue to confirm that I’m moving in the right direction, including some awesome financial aid for tuition!

At first I was itching to finish my education as quickly as possible, but I’m learning to enjoy each step of the journey instead of just focusing on the end result. It’s been a refreshing change in perspective. After a month back in school I feel like I’ve found my groove. The work is challenging but I am energized by the learning. If you’re curious about what I’m learning you can check out my digital flashcards.

Well… I’m off to take a two-hour exam on all the bones in the body and read up on viruses that transfer DNA from one bacteria to another.

REVISED: This blog has been edited based on feedback from the Hearthside Online Midwifery Study Group on Facebook.

Once I decided to become a midwife, the next step was determining what type of midwife to become. It was challenging to find thorough information about the different options. I basically could only find a surface-level overview, which I found completely unsatisfying when making a decision that would impact the rest of my career! To help future aspiring midwifes, I’ve decided to share an overview of the CPM vs. CNM option (Certified Professional Midwife vs. Certified Nurse-Midwife) based on my research.

A variety of opinions

The U.S. is unique in that it offers a variety of routes for becoming a midwife. While the primary licensing organizations are nationwide, each state sets their own regulations. Which means there is a LOT of variety between midwifes with different certifications in different states. A “licensed midwife” is someone who has met the requirements set by the state for licensure. Some states allow for non-licensed midwifes (sometimes called Traditional Midwifes).

There are also different camps of people who are working towards establishing nationwide definitions/regulations and increasing the scope of what midwifes are allowed to do. This leads to a significant amount of debate, and sometimes defensiveness, within the midwifery community.

Certified Professional Midwives (CPM)

Licensed and trained in midwifery only.

You can become a CPM without going to a school. This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process).

If you go to school, you can go to an MEAC accredited school or one that isn’t accredited. Non-accredited schooling requires PEP as well.

Entry-level education for an MEAC accredited school seems to range from Associates to Master’s Degrees

Can practice in most states, but some states will not license CPMs

Can only deliver OOH (Out of Hospital) in the home (if legal in the state) or in a birth center

Does not require physician oversight

Cannot write prescriptions

Care is limited to pregnant or post-partum women in some states. Other states allow well-woman care as well.

A few observations:

This seems to be the preferred route for women who are highly committed to home birth and/or natural birth.

The schooling is regulated, but it seems like training can be inconsistent and highly dependent on the preceptor who trains you (a preceptor is a midwife who trains new midwives). This article has an interesting perspective on “black holes” of knowledge for CPMs.

The autonomy of not having physician oversight is appealing

CPMs typically also become business owners. Some aspiring midwifes prefer the CNM route because they don’t want to own their own business. Others prefer this type of autonomy

CPMs typically practice in 24/7 on call roles and as the years add up they can suffer from burnout. This lifestyle can be challenging on families

The cost of training can vary greatly. Schools I’ve seen can range from $15k to $60k.

The prerequisites for training vary greatly: some schools have no prereqs, others have similar prereqs to nursing schools and other require attending training to become a doula and/or child birth educator.

I met some students who started nursing school and discovered it was not a good fit for them, so they changed to the CPM route so they could focus solely on birth in their education instead of “jumping through the nursing school hoop” (which is a very expensive thing to do)

CPM schools
I looked into a lot of CPM schools. Here’s my personal top picks based on what I found:

For CPMs it looks like a lot of the Masters and PhD programs are primarily focused on research.

Nurse-Midwife (CNM)

Licensed and trained as Registered Nurse and in midwifery.

Entry-level education: Master’s Degrees

Can practice in all states, although their scope (what they’re allowed to do) varies from state to state.

Can deliver in all settings (home, birth center or hospital) depending on state regulations.

Can provide care from “menarche through menopause” (menarche being the first menstrual cycle).

Needs physician oversight in most states

Can write prescriptions

A few observations:

A lot of information I read seems to assume someone is already a nurse when they want to become a midwife, which makes it challenging to figure out what to do if you know you want to be a midwife and nursing is simply part of the journey.

Education requires an RN and a Master’s in Midwifery. There are a variety of ways to accomplish this and as a result the educational path can seem overwhelming to navigate.

Some RN programs require CNA training as a prereq. A few CNMs recommend the CNA training even if it’s not required because it helps reduce the culture shock of nursing school.

The practice on CNM seems to range from the Midwifery Model of Care to the Medical Model (where the CNM practices similar to an OB). This article has an interesting take on the necessity for midwifes to be midwifed, which seems less common for CNMs because of the adage “nurses eat their young”

Doula training is incorporated into the midwifery training so it isn’t a prerequisite.

In states where physician oversight is required it seems like a midwife’s experience is greatly dependent on the model of care of the physician (for example: a mother is 42 weeks, the midwife thinks they should wait for labor to start naturally but the doctor wants to induce)

This option offers career flexibility: a midwife can practice 24/7 on call for a while, then work shifts at a hospital, can move out of midwifery and do other types of nursing or after a few years of experience can become a professor.

The training is expensive (in some cases ranging from $60k-100k)

The prereqs between programs can vary (because there are so many different routes) but along the way it looks highly likely that you’ll take Anatomy & Physiology, Microbiology, Chemistry and some upper division Psychology courses.

I ran into several CPMs who had decided to become CNMs for one reason or another. However, there doesn’t seem to be a smooth way to become a CNM. It’s a lot like starting completely over (educationally speaking).

Certified Midwife

In my research I also came across this option. There seems to be two different definitions: one that is similar to a Licensed Midwife* and one that is similar to the CNM but without the RN. There seems to be some controversy about the existence of the latter option (here is an article I found interesting that touched on this subject and also provides some insight on the history of certification in the U.S.) and when I contacted a school that offered this program they practically encouraged me not to apply since you can only practice in 5 states and it’s hard to find positions since it’s a “pioneering” role.

The most commonly recommended resources

Throughout my research I consistently saw links to these two resources:

Today is the four-year anniversary of my dear niece, Emily Faith. Her life, and my subsequent grief, impacted my decision to become a midwife. When asked why I’m becoming a midwife it’s hard to answer because the motivation is tied to such deep emotions.

A lot of this letter is specifically tied to midwifery and infant loss, but I’ve bolded the portions that seem relevant in other contexts.

—————-

Dear friend,

The death of a baby is one of the greatest tragedies. So much potential wrapped up in that little life; all of the dreams and hopes that will never come to be. It seems completely unnatural for a sweet little child to leave this world without staying very long. The horror and grief I felt after Emily passed away was stronger than anything I’d experience before or since. It took my breath away and it may have been years before I felt like I was able to take a deep one again without being assuaged by grief.

Here are a few things I learned along the way:

Experiencing death changes you; it’s impossible to remain exactly the same in the face of grief. From my observations of other grieving people, there seems to be two options: to become softer or to become harder. I think in a 3rd world country where death will be more common in childbirth, where you are needing to become strong in order to survive in a profession like midwifery, and where you are far from your family, it will probably be easy to become harder. Not necessarily as an intentional choice, butit will be easy to slide into that to protect yourself from agony. But I urge you: in the pain and grief, intentionally choose softness. It seems like it will make you more vulnerable, and in the beginning it will probably feel that way. But in the long run it will make you stronger.

There is no way to avoid the pain. The more you avoid it, the bigger it becomes. Dive straight in. There is an end. Trust me, dear sister. I’ve been there and have found the other side.

And sweet girl, I encourage you: don’t let it eat you up inside.

Take it to our Father. Talk to Him about how this death makes you question things. He is not put off by the reality of how you feel and what you’re thinking. He will reveal who He is to you and bring you Truth and comfort.

Share your pain with others.

I pray that through this experience you will be motivated to learn any skills you can to prevent similar death in the future. These emotions are powerful motivators andpouring grief into something that will have long-term impact honors that person’s live and allows their life to have a ripple effect in this world.

But remember, there are things about this process that are completely outside our control or ability to influence. Learning to be comfortable being out of control and to trust in the sovereignty of God will be something that will bring you strength and comfort. Can you believe that I, of all people, am saying there is comfort in not being in control?

And don’t loose sight of the fact that being a midwife strongly decreases the chances of death. Women and babies will survive because of your presence. Don’t let this loss let you forget that you’re choosing to endure this pain to help prevent it for others in the future. That is beautiful, meaningful and self-less.

I’ve had a nagging feeling that something was coming; that I wanted, no needed, to do something different with my life. I’ve been counting the days until the big 3-0; reflecting on the future and the past. During my 20’s I discovered so many things that I’m passionate about. Many of these revolve around being empathic, strengthening others, distributing information/knowledge, being an advocate, and making a long-term impact.

And the question this year was this: am I living the life I want to live? Am I doing was I was made to do?

Some days the answer was yes. Some days the answer was sort of. Some days the answer was absolutely not. But overall the scale was leaning toward no.

——

If you know me well, you’ve heard the story of my brother’s birth. How my parents couldn’t have additional children but my sister and I prayed for a brother and God delivered. It’s an experience that forever stamped my heart with the knowledge of God.

What I’ve probably never told you is that I have vivid memories of going to the midwife with my mom, watching as her stomach was measured, listening to his beating heart, and looking at picture books full of pregnant bellies and babies growing in utero. I remember watching his birth and falling in love with that sweet little baby boy.

I have countless pictures of me holding babies. Newborns are my favorite! I’ve asked endless questions to my Mom friends about pregnancy, birth and parenting. I’ve read so many articles on these topics that Google and Amazon think I have children! And I still want to learn more.

There’s something magical and powerful about the creation of life that I just can’t get enough of.

——

And unexpectedly, on a day I can’t even pinpoint, these two seemingly unconnected things collided.

That’s when I realized that I. COULD. DO. THIS.

I could spend my life supporting Moms and delivering babies.

I reached out to a midwife I know. Over coffee and her pregnant belly she talked about what drew her to midwifery, about the challenges of the lifestyle she leads, how this process has made her a strong woman, how every labor teachers her something new and just how difficult it was to combine a full course load and 24/7 internship for three years.

As I listened I had my answer: when fully faced with just how difficult the road would be all I could think is THIS IS WHAT I WANT.

And so I leapt. Towards the unknown; towards the pain; towards the joy.